Coding for Group B Streptococcus in Pregnancy
For The Record
Vol. 21 No. 2 P. 28

Group B streptococcus (GBS) is a type of bacteria that is normally
located in the digestive, urinary, and reproductive tracts in both
men and women. It’s also commonly found in pregnant women. In most
cases, it does not cause any problems if properly treated during labor
and delivery. A positive GBS culture result means that the mother
carries the GBS bacteria, not that she or her baby will definitely
become ill. A patient who has the bacteria but does not exhibit any
symptoms is said to be colonized. An infection has occurred if the
bacteria cause symptoms.

A pregnant woman may pass GBS to her baby during a vaginal delivery.
However, medical research indicates that giving IV antibiotics to
the mother during labor and delivery can greatly reduce the frequency
of GBS infection in the baby immediately after birth or during the
first week of life. In pregnant women, GBS may cause a urinary tract
infection, sepsis, chorioamnionitis, postpartum endometritis, pelvic
thrombophlebitis, and endocarditis. GBS identified in the urine should
be treated with antibiotics at the time it is diagnosed.

The ICD-9-CM code assignment of a GBS infection will depend on the
type of infection diagnosed. If the patient has a positive GBS culture
but does not have an infection, assign codes 648.9x, Other current
conditions classifiable elsewhere, plus V02.51, Carrier or suspected
carrier of group B streptococcus. The fifth-digit subclassification
depends on the episode of care for this admission. Code 650 cannot
be assigned with any other pregnancy complication code. A GBS carrier
is considered a complication of pregnancy (AHA Coding
Clinic for ICD-9-CM, 2002, first quarter, pages 14-15
and 1998, fourth quarter, page 61).

When the patient has a positive GBS culture, then codes 648.9x and
V02.51 may be assigned. The physician does not need to document the
word “carrier” to assign code V02.51. If the physician documents that
the patient has an infection, then the code for the infection is assigned
instead of codes 648.9x and V02.51.

Although a positive GBS culture is considered a pregnancy complication,
it is not considered a high-risk pregnancy complication. Therefore,
it is not necessary to assign code V23.89, Other high-risk pregnancy,
as a secondary diagnosis with codes 648.9x and V02.51, since these
codes identify the condition that is making the pregnancy a high-risk
case (AHA Coding Clinic for ICD-9-CM, 2006,
third quarter, page 14).

GBS in Newborns
Patients with GBS culture who do not receive IV antibiotics during
labor and delivery may pass GBS to the baby. If the bacteria are passed
to the baby, the baby may develop GBS infection. However, not all
babies who are exposed to GBS will develop an infection.

According to the Coding Clinic, assign
the appropriate code from category V30, Liveborn infant, as the principal
diagnosis and code V02.51 as a secondary diagnosis for a newborn that
has GBS. “Even though the infant was given antibiotics, he or she
would still be considered a carrier or suspected carrier since there
was no evidence of an infection” (AHA Coding Clinic for
ICD-9-CM, 1994, third quarter, page 4).

Newborns who develop an infection may be classified as an early or
late infection. An early infection may develop shortly after delivery
and up to seven days after birth. A late infection occurs seven days
or more after birth. If an infection develops because of GBS, assign
the appropriate ICD-9-CM code based on the type of infection.

Coding and sequencing for GBS in pregnancy are dependent on the physician
documentation in the medical record and application of the Official
Coding Guidelines for inpatient care. Also, use specific AHA
Coding Clinic for ICD-9-CM and American Medical Association
CPT Assistant references to ensure complete
and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M
Consulting Services. 3M Consulting Services is a business of 3M Health
Information Systems, a supplier of coding and classification systems
to nearly 5,000 healthcare providers. The company and its representatives
do not assume any responsibility for reimbursement decisions or claims
denials made by providers or payers as the result of the misuse of
this coding information. More information about 3M Health Information
Systems is available at www.3mhis.com or by calling 800-367-2447.